A nurse is reviewing the laboratory results of a 5-year-old child who is receiving chemotherapy and has an absolute neutrophil count of 498/mm3 (2,500 to 8,000/mm3). Which of the following actions should the nurse take?

Buck’s traction is a form of skin traction commonly used in pediatric clients with lower extremity fractures to reduce muscle spasms, maintain alignment, and promote comfort prior to definitive treatment. It involves applying a pulling force using weights and a pulley system. Proper nursing care focuses on maintaining correct alignment, preventing complications, and ensuring adequate pain control. Because fractures and traction can cause significant discomfort, effective analgesia is an important part of care.

Rationale:
A. Adjusting the weights to allow the child to turn is incorrect because the traction system must remain continuous and properly aligned at all times. Weights should hang freely without interference to maintain consistent traction force. Altering or adjusting weights can disrupt alignment and compromise treatment effectiveness.

B. Performing pin care every 24 hours is incorrect because Buck’s traction is a skin traction system and does not involve pins. Pin care is only required for skeletal traction where pins are inserted into bone. Since Buck’s traction uses straps and adhesive, pin care is not applicable.

C. Ensuring the pulley mechanism is attached to the child’s skin is incorrect because the pulley system is not attached to the skin but to the traction frame or bed. The skin is only involved through adhesive traction materials. Attaching mechanical components to the skin would be unsafe and inappropriate.

D. Offering opioid medications frequently to reduce pain is appropriate because Buck’s traction and underlying fracture can cause significant pain. Adequate pain control promotes comfort, cooperation, and effective alignment. Opioids are commonly used for moderate to severe pain in pediatric orthopedic injuries when appropriately prescribed and monitored.

Acute sickle cell crisis occurs when sickled red blood cells obstruct microcirculation, leading to tissue ischemia, severe pain, and potential organ damage. Triggers include dehydration, hypoxia, infection, and stress. Nursing management focuses on relieving pain, improving oxygen delivery, and reducing blood viscosity. Adequate hydration is a key intervention because it helps decrease blood viscosity and promotes better circulation through the microvasculature.

Rationale:
A. Administering multiple units of platelets is not indicated in sickle cell crisis because the primary problem is vaso-occlusion by sickled red blood cells, not thrombocytopenia or platelet dysfunction. Platelet transfusion does not address the underlying pathophysiology and is not part of standard management.

B. Preparing to administer potassium IV bolus is inappropriate because potassium supplementation is not a treatment for sickle cell crisis and may be dangerous if not indicated. IV potassium is reserved for documented hypokalemia and must be administered cautiously due to the risk of cardiac dysrhythmias.

C. Providing hydration orally and IV is essential because increased fluid volume reduces blood viscosity and helps prevent further sickling of red blood cells. Adequate hydration improves circulation, supports tissue perfusion, and helps decrease pain associated with vaso-occlusion. This is a cornerstone of acute crisis management.

D. Requesting a prescription for meperidine is inappropriate because this opioid is not recommended for sickle cell pain management due to its neurotoxic metabolite, normeperidine, which can cause seizures. Safer opioid options such as morphine or hydromorphone are preferred for controlling severe pain in sickle cell crisis.